Unsuspected Post-Concussive Symptoms (PCS) in Children Requiring Cervical Spine Clearance

Transcription

1 Unsuspected Post-Concussive Symptoms (PCS) in Children Requiring Cervical Spine Clearance Becky Cook, DNP, CNP, RN Kaaren Shebesta MSN, CNP, RN Mary Ellen Watts, BSN, RN Erin Butt, MSN, CNP, RN Suzanne Moody, MPA, CCRP Richard A. Falcone, Jr, MD, MPH Cincinnati Children s Hospital Medical Center November 14, 2014

2 Disclosures I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity I do not intend to discuss an unapproved/ investigative use of a commercial product/device in my presentation

3 Objectives Discuss high rate of PCS in children requiring c-spine clearance and role of symptom assessment (SA). Emphasize importance of providing anticipatory guidance about PCS to patients released in cervical collars.

4 Background Whiplash & concussion often coincide PCS: Prolonged recovery: ADLs, school, sports Increased risk of secondary injuries Barriers: Young children unable to describe PCS Older children feel invulnerable Concussion Minimized due to primary injury Not appreciated

5 Symptom Assessment (SA) Valuable: Document PCS Timely referral to specialty services Monitor symptom resolution Support care interventions Support patient / family education & reassurance Discharge education significantly reduces: Symptom reporting Behavioral changes

6 SA score: 22 symptoms Scale: 0 6 Score range: Normal score: Boys: 0-6 Girls: 0-8 Abnormal score referral: Sports Medicine Neurology Pediatric Rehab Adapted from: Lovell, et al, 1998

7 Unsuspected PCS Purpose: Determine the incidence of PCS in children seen for c-spine clearance Methods: Incorporated symptom assessment (SA) Retrospective chart review Patients seen in NP Trauma Clinic for c-spine clearance (June 2012 June 2013) Emergency Department Inpatients

8 Patient Demographics N = 244 Age: 5 17 yrs 5 yr: 11 (4%) 6 9 yrs: 28 (12%) > 10 yrs: 205 (84%) Gender: Male: 124 (51%) Female: 120 (49%) Documented SA: 179 (74%) SA Range: 0 95 Mean: 17.4 Mechanism of Injury 20.5% Sport 38.1% MVC 18.9% Fall Other 22.5%

9 Abnormal SA Score N = 98 (55%) 33 Age: 5 17 yrs 32 Gender: 5 yr: 1 (1%) 6 9 yrs: 10 (10%) > 10 yrs: 87 (89%) Male: 36 (37%) Female: 62 (63%) Mean SA Score Female Male SA Range: Mean: SA Range

10 Abnormal SA Score

11 Unsuspected PCS N = (29%) Concussion Dx 127 (71%) No concussion Dx 39 (75%) 13 (25%) 59 (46%) 68 (54%) Abnormal SAS Normal SAS Abnormal SAS Normal SAS

12 Referral to Head Injury Clinic N = (85.6%) follow up Pediatric Rehab Sports Medicine Neurology Mean of 2.1 visits 1-6 visits total

13 Implications Careful screening identified a high rate of unsuspected PCS in children requiring c-spine clearance Formal assessment of PCS incorporated into the evaluation Anticipatory education regarding PCS when released from ED/inpatient setting in a cervical collar

14 Unsuspected PCS Limitations Retrospective review over a 1 year time period No data for children < 5 years Did not distinguish ED vs inpatient outcomes Next steps: Inpatient SA screening prior to discharge (done) Collaboration with ED: Incorporating concussion education Prospective evaluation Screening tool for young children

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